Private Lesson Intake Form

Private Lesson Intake Form
Owner Information

Lessons & Consultations are provided if you live within 30 minutes of Morrisville, VT.
PLEASE READ

You have 2 choices for lessons and both are held in your home.

You can either book a single 90-minute Private Consultation for $275.00

OR

You can book a series of 3, 1-hour lessons for $525.00
Which*

90-Minute Private Consultation3, 1-Hour Lessons
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dog Information
Dog's Name*
Dog's Age*
Dog's Breed or Best Guess*
Sex*

MaleNeutered MaleFemaleSpayed Female
How long have have you owned your dog?*
Where did you get your dog?*
Behavior History
What are the main issues you want help with? (Be specific)*
When did these behaviors begin?*
Have these behaviors gotten better, worse, or stayed the same?*
Where do the issues mainly occur?*

Inside HomeOutside HomeOn WalksAround FamilyAround StrangersAround DogsOther
**IF OTHER, PLEASE DESCRIBE
Have you already tried to fix the issue(s)?*
Have you worked with a trainer or behavior professional before?*
If yes, please describe who you worked with and what was recommended:
Environment & Lifestyle
Who lives in the home with the dog?*
How much daily exercise does your dog currently get?*

Very little1 short walk1 long walkMultiple walksOff leash timeStructured trainingOther
**IF OTHER, PLEASE EXPLAIN
What kind of equipment do you currently use on walks?*
Safety & Severity
Has your dog ever bitten a person? (Nips are bites)*

NoYes, no medical attention neededYes, broken skinYes, drawn bloodYes, needed medical attention
Has your dog ever bitten a dog? (Nips are bites)*

NoYes, no medical attention neededYes, broken skinYes, drawn bloodYes, needed medical attention
Does your dog guard food, toys, space, or people?*
**IF YES, PLEASE EXPLAIN
Your Goals
What would a successful outcome look like for you?*
Why is now the right time to get help?*
Agreement & Expectations
Signature*

Clear
Date*

MonthDayYear
Date
Once Ian reviews your Intake Form, he will contact you.
Should be Empty:

Private Lesson Intake Form

Owner Information

Dog Information

Behavior History

Environment & Lifestyle

Safety & Severity

Your Goals

Agreement & Expectations